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[PMID]:28742291
[Au] Autor:Sultan RS; Olfson M; Correll CU; Duncan EJ
[Ad] Endereço:New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Dr, New York, NY 10032. rs3511@cumc.columbia.edu.
[Ti] Título:Evaluating the Effect of the Changes in FDA Guidelines for Clozapine Monitoring.
[So] Source:J Clin Psychiatry;78(8):e933-e939, 2017 Sep/Oct.
[Is] ISSN:1555-2101
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Concerns exist that clozapine is underutilized in the management of treatment-resistant schizophrenia. Although a 2015 change in the US Food and Drug Administration (FDA) monitoring recommendations lowered the threshold of the absolute neutrophil count for treatment interruption from 1,500/µL to 1,000/µL and removed white blood cell count thresholds from the monitoring algorithm, the implications of this policy change on clozapine interruptions remain unknown. METHODS: We analyzed outpatient prescribing records for antipsychotic medications in the Veterans Integrated Service Network 7 (VISN 7) database between 1999 and 2012 to assess the potential impact of the recent changes in FDA neutropenia monitoring recommendations on clozapine treatment discontinuation. We evaluated results of complete blood count monitoring to compare percentages of patients who developed or would have developed ≥ 1 hematologic event under the previous and current FDA guidelines in the first year following initiation of clozapine. RESULTS: From a cohort of 14,620 patients with schizophrenia (ICD-9-295.x), 246 patients received clozapine treatment (1.7%). No agranulocytosis was observed during the study period. Under the former recommendations, 5 patients in the clozapine initiation cohort (n = 160, 3.1%; 95% CI, 0.43-5.83) qualified for treatment interruption during the first year of clozapine treatment, while only 1 patient (0.6%) qualified under the current recommendations. Under the former recommendations, hematologic events occurred at a similar rate for individuals taking and not taking clozapine. CONCLUSIONS: While clozapine remains an underused medication, the new FDA monitoring guidelines are likely to substantially reduce the percentage of patients who meet criteria for clozapine-associated hematologic events requiring treatment interruption. This decrease may reduce the clinical burden of managing patients on clozapine and therefore increase the number of individuals treated with this uniquely effective medication. However, prospective studies of individuals treated under the new guidelines are needed to fully assess safety of the FDA's change.
[Mh] Termos MeSH primário: Clozapina
Monitoramento de Medicamentos
Neutropenia
Esquizofrenia/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos
Antipsicóticos/administração & dosagem
Antipsicóticos/efeitos adversos
Clozapina/administração & dosagem
Clozapina/efeitos adversos
Monitoramento de Medicamentos/métodos
Monitoramento de Medicamentos/estatística & dados numéricos
Prescrições de Medicamentos/estatística & dados numéricos
Feminino
Seres Humanos
Contagem de Leucócitos
Masculino
Conduta do Tratamento Medicamentoso/organização & administração
Conduta do Tratamento Medicamentoso/normas
Meia-Idade
Neutropenia/induzido quimicamente
Neutropenia/diagnóstico
Neutropenia/epidemiologia
Neutropenia/prevenção & controle
Farmacovigilância
Guias de Prática Clínica como Assunto
Escalas de Graduação Psiquiátrica
Melhoria de Qualidade
Esquizofrenia/diagnóstico
Esquizofrenia/epidemiologia
Estados Unidos/epidemiologia
United States Food and Drug Administration
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antipsychotic Agents); J60AR2IKIC (Clozapine)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE


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[PMID]:28459929
[Au] Autor:Sikkens JJ; van Agtmael MA; Peters EJG; Lettinga KD; van der Kuip M; Vandenbroucke-Grauls CMJE; Wagner C; Kramer MHH
[Ad] Endereço:Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands.
[Ti] Título:Behavioral Approach to Appropriate Antimicrobial Prescribing in Hospitals: The Dutch Unique Method for Antimicrobial Stewardship (DUMAS) Participatory Intervention Study.
[So] Source:JAMA Intern Med;177(8):1130-1138, 2017 Aug 01.
[Is] ISSN:2168-6114
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Inappropriate antimicrobial prescribing leads to antimicrobial resistance and suboptimal clinical outcomes. Changing antimicrobial prescribing is a complex behavioral process that is not often taken into account in antimicrobial stewardship programs. Objective: To examine whether an antimicrobial stewardship approach grounded in behavioral theory and focusing on preserving prescriber autonomy and participation is effective in improving appropriateness of antimicrobial prescribing in hospitals. Design, Setting, and Participants: The Dutch Unique Method for Antimicrobial Stewardship (DUMAS) study was a prospective, stepped-wedge, participatory intervention study performed from October 1, 2011, through December 31, 2015. Outcomes were measured during a baseline period of 16 months and an intervention period of 12 months. The study was performed at 7 clinical departments (2 medical, 3 surgical, and 2 pediatric) in a tertiary care medical center and a general teaching hospital in the Netherlands. Physicians prescribing systemic antimicrobial drugs for any indication for patients admitted to the participating departments during the study period were included in the study. Interventions: We offered prescribers a free choice of how to improve their antimicrobial prescribing. Prescribers were stimulated to choose interventions with higher potential for success based on a root cause analysis of inappropriate prescribing. Main Outcomes and Measures: Appropriateness of antimicrobial prescriptions was determined using a validated approach based on guideline adherence and motivated guideline deviation and measured with repeated point prevalence surveys (6 per year). Appropriateness judgment was masked for the study period. Antimicrobial consumption was extracted from pharmacy records and measured as days of therapy per admission. We used linear and logistic mixed-model regression analysis to model outcomes over time. Results: A total of 1121 patient cases with 700 antimicrobial prescriptions were assessed during the baseline period and 882 patient cases with 531 antimicrobial prescriptions during the intervention period. The mean antimicrobial appropriateness increased from 64.1% at intervention start to 77.4% at 12-month follow-up (+13.3%; relative risk, 1.17; 95% CI, 1.04-1.27), without a change in slope. No decrease in antimicrobial consumption was found. Conclusions and Relevance: Use of a behavioral approach preserving prescriber autonomy resulted in an increase in antimicrobial appropriateness sustained for at least 12 months. The approach is inexpensive and could be easily transferable to various health care environments.
[Mh] Termos MeSH primário: Anti-Infecciosos/uso terapêutico
Atitude do Pessoal de Saúde
Infecções Bacterianas
Resistência Microbiana a Medicamentos/efeitos dos fármacos
Prescrição Inadequada
Melhoria de Qualidade/organização & administração
[Mh] Termos MeSH secundário: Infecções Bacterianas/tratamento farmacológico
Infecções Bacterianas/epidemiologia
Comportamento de Escolha
Fidelidade a Diretrizes
Hospitais/estatística & dados numéricos
Seres Humanos
Prescrição Inadequada/efeitos adversos
Prescrição Inadequada/prevenção & controle
Prescrição Inadequada/psicologia
Prescrição Inadequada/estatística & dados numéricos
Conduta do Tratamento Medicamentoso/organização & administração
Países Baixos/epidemiologia
Padrões de Prática Médica/estatística & dados numéricos
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Infective Agents)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1001/jamainternmed.2017.0946


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[PMID]:29361657
[Au] Autor:Steiner DJ; Thomson Reuters Accelus.
[Ti] Título:Pharmaceuticals and Medical Devices: Cost Savings.
[So] Source:Issue Brief Health Policy Track Serv;2017:1-31, 2017 Dec 26.
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Custos de Medicamentos
Indústria Farmacêutica/economia
Farmacoeconomia/organização & administração
Medicamentos sob Prescrição/economia
[Mh] Termos MeSH secundário: Canadá
Comércio/economia
Redução de Custos
Dedutíveis e Cosseguros
Revelação
Aprovação de Drogas
Custos de Medicamentos/legislação & jurisprudência
Medicamentos Genéricos/economia
Competição Econômica
Farmacoeconomia/legislação & jurisprudência
Epinefrina/economia
Seres Humanos
Adesão à Medicação
Conduta do Tratamento Medicamentoso/economia
Medicamentos sem Prescrição/economia
Farmácias/economia
Equivalência Terapêutica
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Drugs, Generic); 0 (Nonprescription Drugs); 0 (Prescription Drugs); YKH834O4BH (Epinephrine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:180124
[St] Status:MEDLINE


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[PMID]:29233277
[Au] Autor:Hoffman J; Chung E; Hess K; Law AV; Samson B; Scott JD
[Ad] Endereço:Western University of Health Sciences, College of Pharmacy, Pomona, CA, United States. Electronic address: jhoffman@westernu.edu.
[Ti] Título:Overview of a co-curricular professional development program in a college of pharmacy.
[So] Source:Curr Pharm Teach Learn;9(3):398-404, 2017 May.
[Is] ISSN:1877-1300
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The goal of a professional program at a school or college of pharmacy is to produce competent and professional pharmacy practitioners. In 2009, The American College of Clinical Pharmacy published a white paper to assist in the teaching of professionalism in schools/colleges of pharmacy to include traits such as responsibility, commitment to excellence, respect for others, honesty and integrity, and care with compassion. In February 2015, the Accreditation Council for Pharmacy Education released their updated accreditation standards (Standards 2016) which introduced the concept of co-curricular activities (Standard 12.3): experiences that complement, augment, and/or advance what is learned in the formal didactic and experiential curriculum. This article details the Professional Development Curriculum at Western University of Health Sciences (WesternU) College of Pharmacy as a potential educational model that promotes professionalism through mandating co-curricular activities for student pharmacists.
[Mh] Termos MeSH primário: Educação em Farmácia
Competência Profissional
Profissionalismo/educação
Faculdades de Farmácia
[Mh] Termos MeSH secundário: Acreditação/normas
Participação da Comunidade
Currículo
Empatia
Exposições Educativas
Seres Humanos
Relações Interpessoais
Liderança
Conduta do Tratamento Medicamentoso
Responsabilidade Social
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:29233271
[Au] Autor:Howell CK; Reveles KR; Knodel LC; Pattyn NR; Frei CR
[Ad] Endereço:College of Pharmacy, The University of Texas at Austin, Austin, TX; Pharmacotherapy Education and Research Center, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX. Electronic address: crystal.howell@emoryhealthcare.org.
[Ti] Título:Know your medicine: A novel student-led community service learning program.
[So] Source:Curr Pharm Teach Learn;9(3):353-359, 2017 May.
[Is] ISSN:1877-1300
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The objective of this article is to describe the efforts of the student pharmacist organization called Know Your Medicine (KYM) as they conduct medication therapy management (MTM) for older adults and underserved communities. METHODS: Patients brought medications, immunization records, and health concerns to KYM events during academic years 2012-2013 and 2013-2014. Student pharmacists performed health screenings, created personalized medication records (PMR), made recommendations, created personal action plans (PAP), and conducted follow-up phone calls. RESULTS: Student pharmacists provided MTM services for a total of 107 patients. The mean duration of a KYM appointment was 62±21min, and student pharmacists provided a mean of 3.5±2.1 recommendations per patient. Patients had a mean age of 78±11 years, 4.5±3.2 disease states, 6.9±4.6 prescriptions, 1.9±1.9 OTC medications, and 2.8±2.6 vitamins or herbals. At the time of the follow-up phone call, a mean of 2.6±1.9 recommendations per patient had been followed. DISCUSSION AND CONCLUSIONS: Student pharmacists successfully implemented a new MTM program for older adults and underserved communities. This program can serve as an example of how other pharmacy colleges and schools might implement MTM training and real-world MTM experience for their student pharmacists.
[Mh] Termos MeSH primário: Conduta do Tratamento Medicamentoso/organização & administração
Conduta do Tratamento Medicamentoso/estatística & dados numéricos
Estudantes de Farmácia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Relações Comunidade-Instituição
Comorbidade
Prescrições de Medicamentos/estatística & dados numéricos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle
Educação em Farmácia
Feminino
Seres Humanos
Masculino
Aceitação pelo Paciente de Cuidados de Saúde
Polimedicação
Seguridade Social
Telefone
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:29172661
[Au] Autor:Kovács G; Kiss C
[Ad] Endereço:II. Gyermekgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Tuzoltó u. 7-9., 1094.
[Ti] Título:[Novelties in the treatment of pediatric immune thrombocytopenia - 2017].
[Ti] Título:Újdonságok a gyermekkori immunthrombocytopenia kezelésében ­ 2017..
[So] Source:Orv Hetil;158(48):1891-1896, 2017 Dec.
[Is] ISSN:0030-6002
[Cp] País de publicação:Hungary
[La] Idioma:hun
[Ab] Resumo:Immune thrombocitopenia in children is a very variable disease. International recommendations give therapeutic possibilities without strong protocols. In 2011, a therapeutic algorithm was published based on Hungarian practice. Recently, new innovative drugs have been available even in Hungary, so there is a need for modification of the therapeutic protocols. In this summary we give an overview about the current up-to-date management. In infancy and in childhood, high-dose immunglobulin treatment is recommended henceforward. In older children an alternative can be steroid therapy (pulses or long-term low-dose treatment). In resistant cases, a new thrombopoetin receptor stimulant, eltrombopag can be administered. This drug is registered in Hungary, and can very effectively influence the prognosis. Splenectomy is very rare nowadays in children. Immune thrombocytopenia is an unpredictable disease. Cure rate is about 70-80% of the cases, but management of the patients needs special care and specialist. Orv Hetil. 2017; 158(48): 1891-1896.
[Mh] Termos MeSH primário: Benzoatos/uso terapêutico
Hidrazinas/uso terapêutico
Imunoglobulinas Intravenosas/uso terapêutico
Conduta do Tratamento Medicamentoso
Púrpura Trombocitopênica Idiopática/tratamento farmacológico
Pirazóis/uso terapêutico
Esteroides/uso terapêutico
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Resistência a Medicamentos
Seres Humanos
Lactente
Recém-Nascido
Pediatria
Prognóstico
Púrpura Trombocitopênica Idiopática/cirurgia
Esplenectomia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Benzoates); 0 (Hydrazines); 0 (Immunoglobulins, Intravenous); 0 (Pyrazoles); 0 (Steroids); S56D65XJ9G (eltrombopag)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.1556/650.2017.30934


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[PMID]:27771308
[Au] Autor:Colavecchia AC; Putney DR; Johnson ML; Aparasu RR
[Ad] Endereço:Houston Methodist Hospital, Department of Pharmacy, 6565 Fannin St., DB1-09, Houston, TX 77030, United States. Electronic address: accolavecchia@houstonmethodist.org.
[Ti] Título:Discharge medication complexity and 30-day heart failure readmissions.
[So] Source:Res Social Adm Pharm;13(4):857-863, 2017 Jul - Aug.
[Is] ISSN:1934-8150
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Limited research exists regarding Medication Regimen Complexity Index (MRCI) and its utility in identifying patients at risk for hospital readmission. OBJECTIVE: This study evaluates the association between discharge MRCI and 30-day rehospitalization in patients with heart failure (HF) after discharge. METHODS: The study involved a retrospective, cohort study at a large tertiary teaching facility from the University HealthSystem Consortium. The consortium database was used to identify HF patients hospitalized from January 2011 to December 2013. A 30-day readmission was defined as being readmitted to the same hospital within 30 days of discharge with a principal discharge diagnosis of HF. Index hospitalizations was defined as the first hospitalization, and readmission was the subsequent hospitalization for HF. A pilot analysis was conducted to compare manual MRCI collection tool and a computerized scoring MRCI system. Multivariable logistic regression was used to examine the association of computerized MRCI (≥15) and 30-day rehospitalization after controlling for other variables. RESULTS: A total of 1,452 patients were included in the study with 81 patients (5.9%) readmitted within 30 days of discharge. The manual and computerized MRCIs were correlated with an R of 0.74 and R of 0.55. The multivariate logistic regression analysis found computerized MRCI ≥15 (OR: 1.62; 95% CI: 1.01-2.59) was associated with 30-day rehospitalization after controlling for other factors. Patients prescribed angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers, were less likely (OR: 0.54; CI: 0.33-0.89) to be readmitted 30 days after discharge, and patients with coronary artery disease were more likely (OR: 1.76; CI: 1.03-3.00) to be readmitted 30 days after discharge. CONCLUSIONS: The computerized MRCI score was moderately correlated with manual MRCI score. A significant association was found between computerized MRCI and 30-day HF readmission. Such predictive tools may allow pharmacists to prioritize patient care and optimize patient outcomes through medication therapy management.
[Mh] Termos MeSH primário: Técnicas de Apoio para a Decisão
Insuficiência Cardíaca/tratamento farmacológico
Conduta do Tratamento Medicamentoso
Sumários de Alta do Paciente Hospitalar
Alta do Paciente
Readmissão do Paciente
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos
Idoso
Idoso de 80 Anos ou mais
Bases de Dados Factuais
Feminino
Insuficiência Cardíaca/diagnóstico
Seres Humanos
Modelos Lineares
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Razão de Chances
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Centros de Atenção Terciária
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180203
[Lr] Data última revisão:
180203
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:28457021
[Au] Autor:Nielsen TRH; Honoré PH; Rasmussen M; Andersen SE
[Ad] Endereço:Region Zealand Hospital Pharmacy, Logistics and Clinical Pharmacy, Roskilde, Denmark.
[Ti] Título:Clinical Effects of a Pharmacist Intervention in Acute Wards - A Randomized Controlled Trial.
[So] Source:Basic Clin Pharmacol Toxicol;121(4):325-333, 2017 Oct.
[Is] ISSN:1742-7843
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The purpose of the study was to investigate the clinical effect of a clinical pharmacist (CP) intervention upon admission to hospital on inpatient harm and to assess a potential educational bias. Over 16 months, 593 adult patients taking ≥4 medications daily were included from three Danish acute medicine wards. Patients were randomized to either the CP intervention or the usual care (prospective control). To assess a potential educational bias, a retrospective control group was formed by randomization. The CP intervention comprised medication history, medication reconciliation, medication review and entry of proposed prescriptions into the electronic prescribing system. The primary outcome of inpatient harm was identified using triggers from the Institute of Healthcare Improvement Global Trigger Tool. Harms were validated and rated for severity by two independent and blinded outcome panels. Secondary end-points were harms per patient, length of hospital stay, readmissions and 1-year mortality. Harm affected 11% of the patients in the intervention group compared to 17% in the combined control group, odds ratio (OR) 0.57 (CI 0.32-1.02, p = 0.06). The incidence of harm was similar in the intervention and prospective control groups, OR 0.80 (CI 0.40-1.59, p = 0.52) but occurred less frequently in the intervention than in the retrospective control group OR 0.46 (CI 0.25-0.85, p = 0.01). An educational bias from the intervention to the control group might have contributed to this negative outcome. In conclusion, the CP intervention at admission to hospital had no statistically significant effect on inpatient harm.
[Mh] Termos MeSH primário: Prescrição Eletrônica
Pacientes Internados
Reconciliação de Medicamentos
Sistemas de Medicação no Hospital
Conduta do Tratamento Medicamentoso
Farmacêuticos
Serviço de Farmácia Hospitalar
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Dinamarca
Interações Medicamentosas
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle
Feminino
Seres Humanos
Tempo de Internação
Masculino
Erros de Medicação/prevenção & controle
Meia-Idade
Admissão do Paciente
Segurança do Paciente
Polimedicação
Estudos Prospectivos
Estudos Retrospectivos
Fatores de Risco
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180130
[Lr] Data última revisão:
180130
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170501
[St] Status:MEDLINE
[do] DOI:10.1111/bcpt.12802


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[PMID]:28448783
[Au] Autor:Caffiero N; Delate T; Ehizuelen MD; Vogel K
[Ad] Endereço:1 Pharmacy Department, Kaiser Permanente Colorado, Aurora.
[Ti] Título:Effectiveness of a Clinical Pharmacist Medication Therapy Management Program in Discontinuation of Drugs to Avoid in the Elderly.
[So] Source:J Manag Care Spec Pharm;23(5):525-531, 2017 May.
[Is] ISSN:2376-1032
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Despite evidence of fall risk associated with some drugs to avoid in the elderly (DAEs), many aged patients continue to receive them. OBJECTIVE: To assess the effectiveness of a clinical pharmacist medication therapy management program (MTM) on discontinuation of prescribed DAEs. METHODS: This was a retrospective cohort study conducted at an integrated health care delivery system. Kaiser Permanente Colorado beneficiaries aged ≥65 years who were MTM-eligible and targeted for a DAE dispensing between 01/01/2015 and 09/30/2015 were included in the observation group. Medicare beneficiaries who were not eligible for MTM but had a targeted DAE dispensing during the same time period were included in the control group. The percentage of patients with another DAE dispensing of the same specified medication (no matter the strength) during the 100 days following index DAE dispensing was assessed. Univariate and multivariable logistic regression analyses were conducted. RESULTS: A total of 9,059 Medicare beneficiaries were included, with 226 beneficiaries in the MTM group and 8,833 beneficiaries in the non-MTM group. Beneficiaries were primarily female and white and had a high burden of chronic disease. The percentages of patients with another dispensing of the specified DAE were 7.1% (95% CI = 3.7%-10.4%) for the MTM beneficiaries and 35.3% (95% CI 34.2%-36.2%) for the non-MTM beneficiaries (P < 0.001). The OR for the MTM group to have received another dispensing of the specified DAE was 0.12 (95% CI = 0.08-0.22) with adjustment for potential confounders. CONCLUSIONS: A clinical pharmacist-provided MTM intervention was associated with decreased DAE dispensing in Medicare beneficiaries. Future studies should evaluate means to further decrease DAE use in the aged. DISCLOSURES: This study was funded by the Kaiser Permanente Colorado Pharmacy Department. The funder had no role in the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit the manuscript for publication. Delate has received grant funding from Janssen Pharmaceutical Companies of Johnson & Johnson outside of this study. The authors report no other disclosures. Delate supervised the study and had complete access to the data and takes responsibility for the data integrity. Study concept and design were contributed by Caffiero, Delate, Ehizuelen, and Vogel. Delate collected the data, assisted by the other authors, and analysis and interpretation of the data were provided by Ehizuelen and Vogel, along with Caffiero and Delate. The manuscript was written by Caffiero and Delate, with assistance from Ehizuelen and Vogel, and revised by all the authors. Preliminary findings from this study were presented at the Mountain States Conference for Pharmacy Residents, Fellows, and Preceptors on May 13, 2016, in Salt Lake City, Utah.
[Mh] Termos MeSH primário: Prescrição Inadequada/prevenção & controle
Conduta do Tratamento Medicamentoso
Assistência Farmacêutica/organização & administração
Farmacêuticos/organização & administração
[Mh] Termos MeSH secundário: Acidentes por Quedas/prevenção & controle
Idoso
Idoso de 80 Anos ou mais
Estudos de Coortes
Colorado
Prestação Integrada de Cuidados de Saúde/organização & administração
Feminino
Seres Humanos
Modelos Logísticos
Masculino
Medicare
Lista de Medicamentos Potencialmente Inapropriados
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180111
[Lr] Data última revisão:
180111
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.18553/jmcp.2017.23.5.525


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[PMID]:28448781
[Au] Autor:Weddle SC; Rowe AS; Jeter JW; Renwick RC; Chamberlin SM; Franks AS
[Ad] Endereço:1 University of Tennessee Health Science Center College of Pharmacy, Department of Clinical Pharmacy, and the University of Tennessee Medical Center, Department of Pharmacy, Knoxville.
[Ti] Título:Assessment of Clinical Pharmacy Interventions to Reduce Outpatient Use of High-Risk Medications in the Elderly.
[So] Source:J Manag Care Spec Pharm;23(5):520-524, 2017 May.
[Is] ISSN:2376-1032
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Use of high-risk medications in the elderly (HRME) and drug-disease (Rx-DIS) interactions in the elderly, as defined by the Healthcare Effectiveness Data and Information Set (HEDIS) Measures, are significantly associated with mortality, hospital admission, and need for emergency care. No published studies to date evaluate interventions to reduce the use of HEDIS-defined HRME, although many studies have postulated a beneficial effect of such interventions. OBJECTIVE: To evaluate the effect of pharmacist interventions on use of HRME and Rx-DIS interactions in the outpatient elderly population. METHODS: This retrospective cohort study was conducted in a resident-based family medicine clinic. Patients aged ≥ 65 years were prospectively screened for the use of HRME and Rx-DIS interactions before their visits with their primary care providers. If HRME or Rx-DIS interactions were noted, the clinical pharmacist sent messages to the physicians through the electronic medical record, alerting them of the findings with suggestions of safer alternative agents, if applicable. The recommendation acceptance rate was assessed and then compared with a historical control from a similar time frame. The primary outcome was assessed with a chi square analysis. Secondary outcomes were assessed with descriptive statistics, chi square test, and Fisher's exact test. RESULTS: HRME and/or Rx-DIS interactions were changed 25.9% of the time in the pharmacist intervention group compared with only 2.0% of the time in the historical control group (P = 0.001). The most frequently changed medication classes included skeletal muscle relaxants, benzodiazepines, and nonsteroidal anti-inflammatory drugs. Over 85% of the medication changes were preserved at the end of the study period. There was no difference between groups in the number of patients with HRME or Rx-DIS interactions. CONCLUSIONS: Clinical pharmacy interventions result in significant reductions in use of HRME and Rx-DIS interactions in the outpatient elderly population. Using electronic communication allows pharmacists to provide meaningful interventions for numerous patients receiving care in a high-volume family medicine clinic setting. DISCLOSURES: There was no funding or sponsorship for this study. Rowe reports personal fees from The Medicines Company, outside the submitted work. The other authors have nothing to disclose. Study concept and design were contributed by Jeter, Chamberlin, and Weddle, with assistance from Rowe and Franks. Weddle and Renwick collected the data, and data interpretation was performed by Weddle and Rowe, with assistance from Franks. The manuscript was written by Weddle and Rowe and revised by Weddle and Franks, assisted by Chamberlin. The abstract for the completed study was presented at the American College of Clinical Pharmacy Global Conference, San Francisco, California, October 2015, and the Southeastern Residency Conference, Athens, Georgia, April 2015 (platform presentation). The research-in-progress abstract was presented at the Tennessee Society of Health System Pharmacists, Nashville, Tennessee, February 2015; the American Society of Health System Pharmacists Midyear Clinical Meeting, Anaheim, California, December 2014; and the University HealthSystem Consortium Pharmacy Council, Anaheim, California, December 2014.
[Mh] Termos MeSH primário: Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle
Conduta do Tratamento Medicamentoso
Farmacêuticos/organização & administração
Serviço de Farmácia Hospitalar/organização & administração
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Estudos de Coortes
Feminino
Seres Humanos
Masculino
Pacientes Ambulatoriais
Preparações Farmacêuticas/administração & dosagem
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Pharmaceutical Preparations)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180111
[Lr] Data última revisão:
180111
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.18553/jmcp.2017.23.5.520



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